Study setting and participants
This study was conducted in Dubti town in May, 2015. Dubti town is found in zone one of Afar regional state of Ethiopia. It is located 570 kms and 12 kms from Addis Ababa and Samara, respectively. Dubti district is bordered on the south by Somali Regional state, on the Southwest by Mille, on the west by Chifra, on the Northwest by the administrative zone 4, on the north by Kori, on the Northeast by Elidar, on the east by Aysaita and on the Southeast by Afambo districts.
A quantitative community based cross sectional study was employed on mothers of infants aged less than 6 months. A sample size of 346 was calculated using a single population proportion formula;
$$ \mathrm{n}=\frac{{\left(\mathrm{z}\frac{\upalpha}{2}\right)}^2\;\mathrm{p}\;\left(1\;\hbox{-}\;\mathrm{p}\right)}{{\mathrm{d}}^2} $$
Where n = required sample size, \( z\;\frac{\alpha }{2} \) = critical value for normal distribution at 95 % confidence level (1.96), p = prevalence of exclusive breastfeeding in Goba district of Ethiopia (71.3 %) [8], d = 0.05 (5 % margin of error) and an estimated non-response rate of 10 %.
Sampling procedure and data collection process
A pre-survey was done before the actual period of data collection to identify the households which have the targeted mother-child pairs. At the time of survey, from each household unit one eligible mother of infants aged less than 6 months was selected using systematic random sampling technique after identifying an initial starting household by lottery. If there were more than one mother with infants aged less than 6 months in one household unit, one mother with the youngest infant was selected. If mothers had twin infants aged less than 6 months, one infant was selected by lottery. At the time of data collection mothers who were seriously ill and unable to communicate were excluded from the study.
Data were collected by five BSc nursing students using a pre-tested, structured and interviewer administered questionnaire. In this study exclusive of breastfeeding was assessed by using 24-h recall method. The questionnaire was prepared first in English and translated into Qafaraf (the local language), and then back into English to check its consistency. The final Qafaraf (local language) version of the questionnaire was used to collect the data.
Study variables
In this study, the dependent variable was exclusive breastfeeding practice among mothers of infants aged less than 6 months. Exclusive breastfeeding was defined as an infant’s breast milk consumption without supplementation of any type of food or drink, except for vitamins, minerals and necessary medications in the last 24 h preceding the survey [9]. The independent variables were maternal characteristics (age, educational status, religion, occupation, marital status, parity and ethnicity), household characteristics (household head, and family size), infant characteristics (sex, age), husband educational status, health service related variables (site of delivery, mode of delivery, antenatal care and postnatal care). In addition, infant feeding counseling during antenatal care and postnatal care was reported by the mothers. Early initiation of breastfeeding was defined as breastfeeding initiation within 1 h after birth.
Data quality control
BSc nursing students were recruited as data collectors. The data collectors were trained for 2 days on the study instrument, consent form, how to interview and data collection procedures. The questionnaire was pretested, and then the pretest amendments were made accordingly. The supervisors (two health professionals having a master’s degree) had checked the day to day activity of data collectors regarding the completion of questionnaires, clarity of responses and proper coding of the responses.
Data processing and analysis
The data were checked for completeness and inconsistencies. It was also cleaned, coded and entered on to EpiData version 3.02, then exported to SPSS 20.0 statistical package for analysis.
Univariable logistic regression analysis was performed. The crude odds ratio (COR) with 95 % confidence interval was estimated to assess the association between each independent variable and the outcome variable. Variables with p-value < 0.05 in the univariable logistic regression analysis were considered in the multivariable logistic analysis.
The Hosmer-Lemeshow goodness-of-fit with enter procedure was used to test for model fitness. Adjusted Odds Ratio (AOR) with 95 % confidence interval was estimated to assess the strength of the association, and a p-value < 0.05 was used to declare the statistical significance in the multivariable analysis. Variables with p-value < 0.05 in the multivariable logistic regression analysis were considered as significant and independent predictors of exclusive breastfeeding.
Ethical consideration
The study was approved by Samara University, Department of Nursing (no approval numbers are given). An official letter was written from nursing department to Dubti town administration office. The participants enrolled in the study were informed about the study objectives, expected outcomes, benefits and the risks associated with it. A written consent was taken from the participants before the interview. Confidentiality of responses was maintained throughout the study.
